R. D. Fonseka, P. Natarajan, M. Maharaj, Lianne Koinis, L. Sy, R. Mobbs
Background: Outcome measurement in lumbar surgery is traditionally performed using patient questionnaires that may be limited by subjectivity. Objective gait analysis may supplement patient assessment but must be clinically viable. We assessed gait metrics in lumbar spine patients pre- and postoperatively using a small and lightweight wearable sensor. Methods: This was a prospective observational study with intervention including 12 patients undergoing lumbar spine surgery and 24 healthy controls matched based on age and sex. All the subjects underwent gait analysis using the single-point wearable MetaMotionC sensor. The lumbar spine patients also completed traditional patient questionnaires including the Oswestry Disability Index (ODI). Results: The ODI score significantly improved in the patients from the baseline to six weeks postoperatively (42.4 to 22.8; p = 0.01). Simultaneously, the patients demonstrated significant improvements in gait asymmetry (asymmetry in step length, swing time, single support time, and double support time, by 17.4–60.3%; p ≤ 0.039) and variability (variability in gait velocity, step time, step length, stance time, swing time, single support time, and double support time, by 21.0–65.8%; p ≤ 0.023). After surgery, changes in most spatiotemporal (gait velocity, step length, stance time, swing time, and single limb support time) and asymmetry (asymmetry in step time, stance time, swing time, and single limb support time) metrics correlated strongly (magnitude of r = 0.581–0.914) and significantly (p ≤ 0.037) with changes in the ODI. Conclusions: Gait analysis using a single-point wearable sensor can demonstrate objective evidence of recovery in lumbar spine patients after surgery. This may be used as a routine pre- and postoperative assessment during scheduled visits to the clinic.
{"title":"Objective Gait Analysis Using a Single-Point Wearable Sensor to Assess Lumbar Spine Patients Pre- and Postoperatively","authors":"R. D. Fonseka, P. Natarajan, M. Maharaj, Lianne Koinis, L. Sy, R. Mobbs","doi":"10.3390/std13010004","DOIUrl":"https://doi.org/10.3390/std13010004","url":null,"abstract":"Background: Outcome measurement in lumbar surgery is traditionally performed using patient questionnaires that may be limited by subjectivity. Objective gait analysis may supplement patient assessment but must be clinically viable. We assessed gait metrics in lumbar spine patients pre- and postoperatively using a small and lightweight wearable sensor. Methods: This was a prospective observational study with intervention including 12 patients undergoing lumbar spine surgery and 24 healthy controls matched based on age and sex. All the subjects underwent gait analysis using the single-point wearable MetaMotionC sensor. The lumbar spine patients also completed traditional patient questionnaires including the Oswestry Disability Index (ODI). Results: The ODI score significantly improved in the patients from the baseline to six weeks postoperatively (42.4 to 22.8; p = 0.01). Simultaneously, the patients demonstrated significant improvements in gait asymmetry (asymmetry in step length, swing time, single support time, and double support time, by 17.4–60.3%; p ≤ 0.039) and variability (variability in gait velocity, step time, step length, stance time, swing time, single support time, and double support time, by 21.0–65.8%; p ≤ 0.023). After surgery, changes in most spatiotemporal (gait velocity, step length, stance time, swing time, and single limb support time) and asymmetry (asymmetry in step time, stance time, swing time, and single limb support time) metrics correlated strongly (magnitude of r = 0.581–0.914) and significantly (p ≤ 0.037) with changes in the ODI. Conclusions: Gait analysis using a single-point wearable sensor can demonstrate objective evidence of recovery in lumbar spine patients after surgery. This may be used as a routine pre- and postoperative assessment during scheduled visits to the clinic.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139779135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. D. Fonseka, P. Natarajan, M. Maharaj, Lianne Koinis, L. Sy, R. Mobbs
Background: Outcome measurement in lumbar surgery is traditionally performed using patient questionnaires that may be limited by subjectivity. Objective gait analysis may supplement patient assessment but must be clinically viable. We assessed gait metrics in lumbar spine patients pre- and postoperatively using a small and lightweight wearable sensor. Methods: This was a prospective observational study with intervention including 12 patients undergoing lumbar spine surgery and 24 healthy controls matched based on age and sex. All the subjects underwent gait analysis using the single-point wearable MetaMotionC sensor. The lumbar spine patients also completed traditional patient questionnaires including the Oswestry Disability Index (ODI). Results: The ODI score significantly improved in the patients from the baseline to six weeks postoperatively (42.4 to 22.8; p = 0.01). Simultaneously, the patients demonstrated significant improvements in gait asymmetry (asymmetry in step length, swing time, single support time, and double support time, by 17.4–60.3%; p ≤ 0.039) and variability (variability in gait velocity, step time, step length, stance time, swing time, single support time, and double support time, by 21.0–65.8%; p ≤ 0.023). After surgery, changes in most spatiotemporal (gait velocity, step length, stance time, swing time, and single limb support time) and asymmetry (asymmetry in step time, stance time, swing time, and single limb support time) metrics correlated strongly (magnitude of r = 0.581–0.914) and significantly (p ≤ 0.037) with changes in the ODI. Conclusions: Gait analysis using a single-point wearable sensor can demonstrate objective evidence of recovery in lumbar spine patients after surgery. This may be used as a routine pre- and postoperative assessment during scheduled visits to the clinic.
{"title":"Objective Gait Analysis Using a Single-Point Wearable Sensor to Assess Lumbar Spine Patients Pre- and Postoperatively","authors":"R. D. Fonseka, P. Natarajan, M. Maharaj, Lianne Koinis, L. Sy, R. Mobbs","doi":"10.3390/std13010004","DOIUrl":"https://doi.org/10.3390/std13010004","url":null,"abstract":"Background: Outcome measurement in lumbar surgery is traditionally performed using patient questionnaires that may be limited by subjectivity. Objective gait analysis may supplement patient assessment but must be clinically viable. We assessed gait metrics in lumbar spine patients pre- and postoperatively using a small and lightweight wearable sensor. Methods: This was a prospective observational study with intervention including 12 patients undergoing lumbar spine surgery and 24 healthy controls matched based on age and sex. All the subjects underwent gait analysis using the single-point wearable MetaMotionC sensor. The lumbar spine patients also completed traditional patient questionnaires including the Oswestry Disability Index (ODI). Results: The ODI score significantly improved in the patients from the baseline to six weeks postoperatively (42.4 to 22.8; p = 0.01). Simultaneously, the patients demonstrated significant improvements in gait asymmetry (asymmetry in step length, swing time, single support time, and double support time, by 17.4–60.3%; p ≤ 0.039) and variability (variability in gait velocity, step time, step length, stance time, swing time, single support time, and double support time, by 21.0–65.8%; p ≤ 0.023). After surgery, changes in most spatiotemporal (gait velocity, step length, stance time, swing time, and single limb support time) and asymmetry (asymmetry in step time, stance time, swing time, and single limb support time) metrics correlated strongly (magnitude of r = 0.581–0.914) and significantly (p ≤ 0.037) with changes in the ODI. Conclusions: Gait analysis using a single-point wearable sensor can demonstrate objective evidence of recovery in lumbar spine patients after surgery. This may be used as a routine pre- and postoperative assessment during scheduled visits to the clinic.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Although robot-assisted laparoscopic surgery has become more in popular, it remains unclear what clinical advantages it offers over conventional laparoscopic surgery. Objective: This (systematic) umbrella review aims to synthesize and compare the clinical outcomes of robot-assisted laparoscopic surgery versus conventional laparoscopic surgery. Methods: A systematic literature search was conducted in PubMed and Scopus. All systematic reviews and meta-analyses published in the past five years that compared the clinical outcomes for cholecystectomy, colectomy, hysterectomy, nephrectomy, and/or prostatectomy were included. The quality of all included reviews was assessed with the AMSTAR 2 quality assessment tool. Each review’s study characteristics and primary sources were extracted, along with the quantitative and qualitative data for blood loss, rate of conversion to open surgery, hospitalization costs, incisional hernia rate, intraoperative complication rate, postoperative complication rate, length of hospital stay, operative time, readmission rate, and wound infection. Results: Fifty-two systematic reviews and (network) meta-analyses were included in this umbrella review, covering more than 1,288,425 patients from 1046 primary sources published between 1996 and 2022. The overall quality of the included reviews was assessed to be low or critically low. Robot-assisted laparoscopic surgery yielded comparable results to conventional laparoscopic surgery in terms of blood loss, conversion to open surgery rate, intraoperative complication rate, postoperative complication rate, readmission rate, and wound infection rate for most surgical procedures. While the hospitalization costs of robot-assisted laparoscopic surgery were higher and the operative times of robot-assisted laparoscopic surgery were longer than conventional laparoscopic surgery, robot-assisted laparoscopic surgery reduced the length of hospital stay of patients in nearly all cases. Conclusion: Robot-assisted laparoscopic surgery achieved comparable results with conventional laparoscopic surgery for cholecystectomy, colectomy, hysterectomy, nephrectomy, and prostatectomy based on ten clinical outcomes.
{"title":"A Comparison of Clinical Outcomes of Robot-Assisted and Conventional Laparoscopic Surgery","authors":"Storm Chabot, J. Calleja-Agius, T. Horeman","doi":"10.3390/std13010003","DOIUrl":"https://doi.org/10.3390/std13010003","url":null,"abstract":"Background: Although robot-assisted laparoscopic surgery has become more in popular, it remains unclear what clinical advantages it offers over conventional laparoscopic surgery. Objective: This (systematic) umbrella review aims to synthesize and compare the clinical outcomes of robot-assisted laparoscopic surgery versus conventional laparoscopic surgery. Methods: A systematic literature search was conducted in PubMed and Scopus. All systematic reviews and meta-analyses published in the past five years that compared the clinical outcomes for cholecystectomy, colectomy, hysterectomy, nephrectomy, and/or prostatectomy were included. The quality of all included reviews was assessed with the AMSTAR 2 quality assessment tool. Each review’s study characteristics and primary sources were extracted, along with the quantitative and qualitative data for blood loss, rate of conversion to open surgery, hospitalization costs, incisional hernia rate, intraoperative complication rate, postoperative complication rate, length of hospital stay, operative time, readmission rate, and wound infection. Results: Fifty-two systematic reviews and (network) meta-analyses were included in this umbrella review, covering more than 1,288,425 patients from 1046 primary sources published between 1996 and 2022. The overall quality of the included reviews was assessed to be low or critically low. Robot-assisted laparoscopic surgery yielded comparable results to conventional laparoscopic surgery in terms of blood loss, conversion to open surgery rate, intraoperative complication rate, postoperative complication rate, readmission rate, and wound infection rate for most surgical procedures. While the hospitalization costs of robot-assisted laparoscopic surgery were higher and the operative times of robot-assisted laparoscopic surgery were longer than conventional laparoscopic surgery, robot-assisted laparoscopic surgery reduced the length of hospital stay of patients in nearly all cases. Conclusion: Robot-assisted laparoscopic surgery achieved comparable results with conventional laparoscopic surgery for cholecystectomy, colectomy, hysterectomy, nephrectomy, and prostatectomy based on ten clinical outcomes.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140475680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Mai, Renée A. van Stralen, Sophie Moerman, Christiaan J. A. van Bergen
Background: Developmental dysplasia of the hip (DDH) is a common disorder of atypical hip development. Pelvic osteotomy (e.g., according to Salter, Pemberton or Dega) may be indicated for children with DDH at walking age. The most popular postoperative treatment is a hip spica cast. Alternative postoperative options include abduction braces and non-weightbearing protocols combined with physical therapy. The aim of this systematic review was to determine the most effective form of postoperative treatment after unilateral pelvic osteotomy in children with DDH in terms of clinical and radiological outcomes and complications. Methods: A systematic review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines and registered in the international prospective register of systematic reviews. Articles were selected from PubMed, Embase and Cochrane databases. The quality of all (non-)randomized included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The search strategy yielded 3524 articles. Fourteen articles with 367 total hips were included in this review. A total of 312 hips were treated with spica casts, 49 with abduction braces and 6 with non-weightbearing protocols. The quality of evidence was moderate (MINORS, 3–12 points). All types of postoperative treatments had good clinical outcomes overall, without secondary displacement of the osteotomy. Clinical outcomes for spica casts were reported according to McKay’s criteria in 135 hips, with 123 excellent and 12 good results. Clinical outcomes for abduction braces showed satisfaction for all parents (49 of 49). The radiological outcome was overall well preserved with any postoperative treatment. There was a higher complication rate with the use of hip spica casts, including avascular necrosis, pain complaints and superficial infections. Conclusion: This systematic review showed no benefit of postoperative spica casts compared with abduction braces and avoidance of weightbearing after simple pelvic osteotomy for residual DDH.
{"title":"Postoperative Cast Immobilization Might Be Unnecessary after Pelvic Osteotomy for Children with Developmental Hip Dysplasia: A Systematic Review","authors":"Mohamed Mai, Renée A. van Stralen, Sophie Moerman, Christiaan J. A. van Bergen","doi":"10.3390/std13010002","DOIUrl":"https://doi.org/10.3390/std13010002","url":null,"abstract":"Background: Developmental dysplasia of the hip (DDH) is a common disorder of atypical hip development. Pelvic osteotomy (e.g., according to Salter, Pemberton or Dega) may be indicated for children with DDH at walking age. The most popular postoperative treatment is a hip spica cast. Alternative postoperative options include abduction braces and non-weightbearing protocols combined with physical therapy. The aim of this systematic review was to determine the most effective form of postoperative treatment after unilateral pelvic osteotomy in children with DDH in terms of clinical and radiological outcomes and complications. Methods: A systematic review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines and registered in the international prospective register of systematic reviews. Articles were selected from PubMed, Embase and Cochrane databases. The quality of all (non-)randomized included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The search strategy yielded 3524 articles. Fourteen articles with 367 total hips were included in this review. A total of 312 hips were treated with spica casts, 49 with abduction braces and 6 with non-weightbearing protocols. The quality of evidence was moderate (MINORS, 3–12 points). All types of postoperative treatments had good clinical outcomes overall, without secondary displacement of the osteotomy. Clinical outcomes for spica casts were reported according to McKay’s criteria in 135 hips, with 123 excellent and 12 good results. Clinical outcomes for abduction braces showed satisfaction for all parents (49 of 49). The radiological outcome was overall well preserved with any postoperative treatment. There was a higher complication rate with the use of hip spica casts, including avascular necrosis, pain complaints and superficial infections. Conclusion: This systematic review showed no benefit of postoperative spica casts compared with abduction braces and avoidance of weightbearing after simple pelvic osteotomy for residual DDH.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139529293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniele Vitali, P. Orlando, G. Maggiore, O. Gallo, Ilaria Bindi
Objectives: The deep submucosal migration of ingested foreign bodies into the pharyngolaryngeal mucosa is a sporadic event, and its management can be very challenging. In the case of the failure of endoscopic retrieval, open surgical techniques are usually required, and intraoperative ultrasonography can become a useful adjunct for identifying their precise localization. Methods: An 84-year-old woman presented with new-onset dysphagia and odynophagia after the accidental ingestion of a fragment of a toothpick a few hours before in the absence of hoarseness or respiratory distress. Ultrasonography and an unenhanced CT scan of the neck revealed a 3 cm linear foreign body embedded into the neck between the left pyriform sinus and the esophageal wall. Results: We report the removal of a fragment of a wooden toothpick deeply lodged between the left pyriform sinus and the esophageal wall, which was managed via an open transcervical approach with the aid of intraoperative ultrasound guidance. Conclusions: We suggest that both preoperative and intraoperative ultrasonography should represent the first-line imaging technique for deeply embedded neck foreign bodies.
{"title":"Ultrasound-Assisted Removal of a Wooden Foreign Body Embedded in the Neck","authors":"Daniele Vitali, P. Orlando, G. Maggiore, O. Gallo, Ilaria Bindi","doi":"10.3390/std13010001","DOIUrl":"https://doi.org/10.3390/std13010001","url":null,"abstract":"Objectives: The deep submucosal migration of ingested foreign bodies into the pharyngolaryngeal mucosa is a sporadic event, and its management can be very challenging. In the case of the failure of endoscopic retrieval, open surgical techniques are usually required, and intraoperative ultrasonography can become a useful adjunct for identifying their precise localization. Methods: An 84-year-old woman presented with new-onset dysphagia and odynophagia after the accidental ingestion of a fragment of a toothpick a few hours before in the absence of hoarseness or respiratory distress. Ultrasonography and an unenhanced CT scan of the neck revealed a 3 cm linear foreign body embedded into the neck between the left pyriform sinus and the esophageal wall. Results: We report the removal of a fragment of a wooden toothpick deeply lodged between the left pyriform sinus and the esophageal wall, which was managed via an open transcervical approach with the aid of intraoperative ultrasound guidance. Conclusions: We suggest that both preoperative and intraoperative ultrasonography should represent the first-line imaging technique for deeply embedded neck foreign bodies.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Quan Rui Tan, Russell Andrew Wong, Arun-Kumar Kaliya-Perumal, J. Oh
The main advantage of Oblique Lumbar Interbody Fusion (OLIF) is its ability to provide safe access to the lumbar spine while being a robust interbody fusion technique through a minimally invasive approach. This study reviews the postoperative complications of OLIF, offering a comprehensive understanding of its advantages and disadvantages. A total of 27 studies with 1275 patients were shortlisted based on our selection criteria. Complications were categorized into intra-operative, immediate post-operative, and delayed post-operative and were interpreted based on surgical procedure into stand-alone OLIF, OLIF with posterior stabilisation, and unspecified. Major complications exhibited a pooled prevalence of just 1.7%, whereas the overall pooled prevalence of complications was 24.7%. Among the subgroups, the stand-alone subgroup had the lowest prevalence of complications (14.6%) compared to the unspecified subgroup (29.6%) and the OLIF L2-5 with posterior stabilisation subgroup (25.8%). Similarly, for major complications, the stand-alone subgroup had the lowest prevalence (1.4%), while the OLIF L2-5 with posterior stabilisation subgroup (1.8%) and the unspecified OLIF L2-5 subgroup (1.6%) had higher rates. However, the differences were not statistically significant. In conclusion, the rate of major complications after OLIF is minimal, making it a safe procedure with significant benefits outweighing the risks. The advantages of OLIF L2-5 with posterior stabilisation over stand-alone OLIF L2-5 is a subject of discussion.
{"title":"Complications Associated with Oblique Lumbar Interbody Fusion: A Systematic Review","authors":"Quan Rui Tan, Russell Andrew Wong, Arun-Kumar Kaliya-Perumal, J. Oh","doi":"10.3390/std12040020","DOIUrl":"https://doi.org/10.3390/std12040020","url":null,"abstract":"The main advantage of Oblique Lumbar Interbody Fusion (OLIF) is its ability to provide safe access to the lumbar spine while being a robust interbody fusion technique through a minimally invasive approach. This study reviews the postoperative complications of OLIF, offering a comprehensive understanding of its advantages and disadvantages. A total of 27 studies with 1275 patients were shortlisted based on our selection criteria. Complications were categorized into intra-operative, immediate post-operative, and delayed post-operative and were interpreted based on surgical procedure into stand-alone OLIF, OLIF with posterior stabilisation, and unspecified. Major complications exhibited a pooled prevalence of just 1.7%, whereas the overall pooled prevalence of complications was 24.7%. Among the subgroups, the stand-alone subgroup had the lowest prevalence of complications (14.6%) compared to the unspecified subgroup (29.6%) and the OLIF L2-5 with posterior stabilisation subgroup (25.8%). Similarly, for major complications, the stand-alone subgroup had the lowest prevalence (1.4%), while the OLIF L2-5 with posterior stabilisation subgroup (1.8%) and the unspecified OLIF L2-5 subgroup (1.6%) had higher rates. However, the differences were not statistically significant. In conclusion, the rate of major complications after OLIF is minimal, making it a safe procedure with significant benefits outweighing the risks. The advantages of OLIF L2-5 with posterior stabilisation over stand-alone OLIF L2-5 is a subject of discussion.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139258754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tajrian Amin, William C. H. Parr, Pragadesh Natarajan, Andrew Lennox, Lianne Koinis, Ralph J. Mobbs
Introduction: Hemivertebrae are a common defect of vertebral formation, potentially resulting in debilitating congenital scoliosis and necessitating highly traumatic surgery. Virtual surgical planning (VSP) and 3D-printed patient-specific implants (PSIs) have increasingly been applied to complex spinal surgery, and offer a range of potential benefits. Research Question: We report the use of 3D-printed PSIs and VSP as part of a two-level anterior lumbar interbody fusion (ALIF) for the management of lateral hemivertebra and congenital scoliosis. Material and Methods: A 53-year-old male with chronic low-back pain, due to L4 hemivertebra and mild congenital scoliosis, presented with new-onset leg pain. CT revealed L4/5 and L5/S1 degeneration and foraminal stenosis. Given the complex anatomy and extensive multi-level osteophytosis, 3D-printed PSIs were designed, manufactured, and implanted as part of a two-level ALIF. Results: Excellent implant fit was achieved intraoperatively, confirmed via postoperative imaging. VSP assisted with navigating challenging bony and vascular anatomy. Three-month postoperative imaging demonstrated construct stability, early signs of bony fusion, with implant placement, spinal curvature, and disc height corrections closely matching the VSP. Clinically, the patient’s pain and functional impairment had effectively resolved by nine-month follow up, as demonstrated through subjective and objective measures. Discussion and Conclusions: Virtual surgical planning and 3D-printed PSIs can be useful surgical aids in the management of the often-complex cases involving hemivertebrae and congenital scoliosis. This case of congenital pathology adds to the growing reports of PSI application to a variety of complex spinal pathologies, with analyses showing a close match of the postoperative construct to the preoperative VSP.
{"title":"Anterior Lumbar Interbody Fusion (ALIF) for Lumbar Hemivertebra in an Adult Using Three-Dimensional-Printed Patient-Specific Implants and Virtual Surgery Planning: A Technical Report","authors":"Tajrian Amin, William C. H. Parr, Pragadesh Natarajan, Andrew Lennox, Lianne Koinis, Ralph J. Mobbs","doi":"10.3390/std12040019","DOIUrl":"https://doi.org/10.3390/std12040019","url":null,"abstract":"Introduction: Hemivertebrae are a common defect of vertebral formation, potentially resulting in debilitating congenital scoliosis and necessitating highly traumatic surgery. Virtual surgical planning (VSP) and 3D-printed patient-specific implants (PSIs) have increasingly been applied to complex spinal surgery, and offer a range of potential benefits. Research Question: We report the use of 3D-printed PSIs and VSP as part of a two-level anterior lumbar interbody fusion (ALIF) for the management of lateral hemivertebra and congenital scoliosis. Material and Methods: A 53-year-old male with chronic low-back pain, due to L4 hemivertebra and mild congenital scoliosis, presented with new-onset leg pain. CT revealed L4/5 and L5/S1 degeneration and foraminal stenosis. Given the complex anatomy and extensive multi-level osteophytosis, 3D-printed PSIs were designed, manufactured, and implanted as part of a two-level ALIF. Results: Excellent implant fit was achieved intraoperatively, confirmed via postoperative imaging. VSP assisted with navigating challenging bony and vascular anatomy. Three-month postoperative imaging demonstrated construct stability, early signs of bony fusion, with implant placement, spinal curvature, and disc height corrections closely matching the VSP. Clinically, the patient’s pain and functional impairment had effectively resolved by nine-month follow up, as demonstrated through subjective and objective measures. Discussion and Conclusions: Virtual surgical planning and 3D-printed PSIs can be useful surgical aids in the management of the often-complex cases involving hemivertebrae and congenital scoliosis. This case of congenital pathology adds to the growing reports of PSI application to a variety of complex spinal pathologies, with analyses showing a close match of the postoperative construct to the preoperative VSP.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135391047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The main concern in anterior exposure of the lumbosacral spine is the risk of vascular injury during mobilization and retraction of the blood vessels. Preoperative planning is considered essential to reducing the incidence of vascular injury, although no consensus has been reached on the preferred methodology for such planning. This is a retrospective study, including all patients operated on by a single surgeon, who received anterior lumbar-spine surgery in the supine position as a primary procedure before undergoing an anterior lumbar interbody fusion (ALIF) or an artificial disc replacement (ADR). The aim of this study was to list the intraoperative complications observed. We included 156 patients (87 women; mean age, 48 years) who met the inclusion criteria. The overall complication rate was 6.4% (10/156). The most frequent complications were an incidental peritoneal opening (seven patients, 4.4%); two left–iliac-vein injuries (1.28%) that were sutured; and one dural tear during a decompression maneuver of the canal. No neurological, arterial, or ureteral injury or retrograde ejaculation was reported. The use of a sound protocol that includes planning, assessment of approach difficulty, and step-by-step surgical technique can reduce the rate of vascular injury in anterior lumbosacral-spine surgery.
{"title":"Intraoperative Complications of the Anterior Retroperitoneal Approach to the Lumbosacral Spine in the Supine Position: A Proposal for an Algorithm to Predict the Degree of Difficulty of the Surgical Procedure","authors":"Francesco Caiazzo, Lucas Capo, Juan Bago","doi":"10.3390/std12040018","DOIUrl":"https://doi.org/10.3390/std12040018","url":null,"abstract":"The main concern in anterior exposure of the lumbosacral spine is the risk of vascular injury during mobilization and retraction of the blood vessels. Preoperative planning is considered essential to reducing the incidence of vascular injury, although no consensus has been reached on the preferred methodology for such planning. This is a retrospective study, including all patients operated on by a single surgeon, who received anterior lumbar-spine surgery in the supine position as a primary procedure before undergoing an anterior lumbar interbody fusion (ALIF) or an artificial disc replacement (ADR). The aim of this study was to list the intraoperative complications observed. We included 156 patients (87 women; mean age, 48 years) who met the inclusion criteria. The overall complication rate was 6.4% (10/156). The most frequent complications were an incidental peritoneal opening (seven patients, 4.4%); two left–iliac-vein injuries (1.28%) that were sutured; and one dural tear during a decompression maneuver of the canal. No neurological, arterial, or ureteral injury or retrograde ejaculation was reported. The use of a sound protocol that includes planning, assessment of approach difficulty, and step-by-step surgical technique can reduce the rate of vascular injury in anterior lumbosacral-spine surgery.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135730330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Conticchio, Antonella Delvecchio, Valentina Ferraro, Matteo Stasi, Annachiara Casella, Rosalinda Filippo, Michele Tedeschi, Alba Fiorentino, Riccardo Memeo
Backgrounds: Liver surgery has developed progressively during the last 10 years, especially in minimally invasive approaches. Robotic surgery seemed to overcome laparoscopic limitations with 3D visualization, the increased degrees of freedom given with Endowrist instruments, tremor filtering, better dexterity, and improved ergonomics for the surgeon. Methods: This work was a retrospective analysis of our first 100 robotic hepatectomies from March 2020 to July 2022. Patient demographics characteristics and intra- and postoperative outcomes were analyzed. Results: A total of 59 males and 41 females, with a median age of 68 years, underwent a robotic liver resection. The indications for robotic liver resections were malignant lesions in 86% of patients. Anatomical resection (AR) was undertaken in 27% of cases and non-anatomical resection (NAR) in 63% of cases. None of the patients were converted to the ‘open’ approach. Postoperative complications were as follows: 1% of biliary leakage, 5% of ascites, 6% of pulmonary infections, and 3% of other sites’ infections. CONCLUSIONS Our results showed the satisfactory experience of a tertiary HPB center with its first 100 robotic liver resections. The opportunity to make the robotic approach routinary provided global growth of a surgical team, improving the quality of patient outcomes.
{"title":"Robotic Liver Resection: Report of Institutional First 100 Cases","authors":"Maria Conticchio, Antonella Delvecchio, Valentina Ferraro, Matteo Stasi, Annachiara Casella, Rosalinda Filippo, Michele Tedeschi, Alba Fiorentino, Riccardo Memeo","doi":"10.3390/std12040017","DOIUrl":"https://doi.org/10.3390/std12040017","url":null,"abstract":"Backgrounds: Liver surgery has developed progressively during the last 10 years, especially in minimally invasive approaches. Robotic surgery seemed to overcome laparoscopic limitations with 3D visualization, the increased degrees of freedom given with Endowrist instruments, tremor filtering, better dexterity, and improved ergonomics for the surgeon. Methods: This work was a retrospective analysis of our first 100 robotic hepatectomies from March 2020 to July 2022. Patient demographics characteristics and intra- and postoperative outcomes were analyzed. Results: A total of 59 males and 41 females, with a median age of 68 years, underwent a robotic liver resection. The indications for robotic liver resections were malignant lesions in 86% of patients. Anatomical resection (AR) was undertaken in 27% of cases and non-anatomical resection (NAR) in 63% of cases. None of the patients were converted to the ‘open’ approach. Postoperative complications were as follows: 1% of biliary leakage, 5% of ascites, 6% of pulmonary infections, and 3% of other sites’ infections. CONCLUSIONS Our results showed the satisfactory experience of a tertiary HPB center with its first 100 robotic liver resections. The opportunity to make the robotic approach routinary provided global growth of a surgical team, improving the quality of patient outcomes.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amniotic Band Syndrome (ABS) is a complex condition characterized by constricting rings and tissue synechiae, resulting in tissue necrosis and congenital anomalies. In newborns and infants with ABS, tissue necrosis can be profound, requiring a tissue defect reconstruction, realized by a Keystone Perforator Island Flap (KF). Primarily used for reconstruction after skin cancer excisions, KF’s applications expanded to defects of various etiologies and disorders throughout the body. Subsequently, additional KF types adapted to the particular tissue defects were developed. The KF’s preparation is relatively simple to perform leading to shorter operative times, and the postoperative monitoring is less laborious. Individualized surgical approaches and timing are essential for addressing the varied manifestations of ABS, with immediate treatment recommended for vascular compression, all-layered tissue necrosis, and nerve compression cases. To our knowledge, there is no published case in which a KF was used for the reconstruction of tissue defects and release of constriction rings in the context of an amniotic band syndrome. Therefore, the purpose of this article is to introduce the established surgical technique of KFs as an innovative surgical approach with satisfying reconstructive results for tissue defects and constriction ring release in ABS.
羊膜带综合征(Amniotic Band Syndrome, ABS)是一种以缩环和组织粘连为特征的复杂疾病，可导致组织坏死和先天性异常。新生儿和婴儿ABS，组织坏死可能是严重的，需要组织缺损重建，通过拱心石穿支岛皮瓣(KF)实现。主要用于皮肤癌切除后的重建，KF的应用扩展到全身各种病因和疾病的缺陷。随后，开发了适应特定组织缺陷的其他KF类型。KF的准备相对简单，可缩短手术时间，术后监测也不那么费力。个体化的手术方式和时机对于解决ABS的各种表现至关重要，对于血管压迫、全层组织坏死和神经压迫的病例，建议立即治疗。据我们所知，在羊膜带综合征的情况下，没有发表过KF用于组织缺损重建和收缩环释放的病例。因此，本文的目的是介绍已建立的KFs手术技术，作为一种创新的手术方法，对ABS组织缺损和收缩环释放具有满意的重建效果。
{"title":"Keystone Flap in Amniotic Band Syndrome—Innovative Approach of an Established Operative Technique for an Unusual Entity","authors":"Dominik Promny, Raymund E. Horch, Theresa Promny","doi":"10.3390/std12040016","DOIUrl":"https://doi.org/10.3390/std12040016","url":null,"abstract":"Amniotic Band Syndrome (ABS) is a complex condition characterized by constricting rings and tissue synechiae, resulting in tissue necrosis and congenital anomalies. In newborns and infants with ABS, tissue necrosis can be profound, requiring a tissue defect reconstruction, realized by a Keystone Perforator Island Flap (KF). Primarily used for reconstruction after skin cancer excisions, KF’s applications expanded to defects of various etiologies and disorders throughout the body. Subsequently, additional KF types adapted to the particular tissue defects were developed. The KF’s preparation is relatively simple to perform leading to shorter operative times, and the postoperative monitoring is less laborious. Individualized surgical approaches and timing are essential for addressing the varied manifestations of ABS, with immediate treatment recommended for vascular compression, all-layered tissue necrosis, and nerve compression cases. To our knowledge, there is no published case in which a KF was used for the reconstruction of tissue defects and release of constriction rings in the context of an amniotic band syndrome. Therefore, the purpose of this article is to introduce the established surgical technique of KFs as an innovative surgical approach with satisfying reconstructive results for tissue defects and constriction ring release in ABS.","PeriodicalId":40379,"journal":{"name":"Surgical Techniques Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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